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16.10.2021 | Original Article

How cancer programs identify and address the financial burdens of rural cancer patients

verfasst von: Victoria Petermann, Whitney E. Zahnd, Robin C. Vanderpool, Jan M. Eberth, Catherine Rohweder, Randall Teal, Maihan Vu, Lindsay Stradtman, Elizabeth Frost, Erika Trapl, Sarah Koopman Gonzalez, Thuy Vu, Linda K. Ko, Allison Cole, Paige E. Farris, Jackilen Shannon, Jessica Lee, Natoshia Askelson, Laura Seegmiller, Arica White, Jean Edward, Melinda Davis, Stephanie B. Wheeler

Erschienen in: Supportive Care in Cancer | Ausgabe 3/2022

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Abstract

Purpose

Financial toxicity is associated with negative patient outcomes, and rural populations are disproportionately affected by the high costs of cancer care compared to urban populations. Our objective was to (1) understand cancer programs’ perceptions of rural–urban differences in cancer patients’ experiences of financial hardship, (2) evaluate the resources available to cancer patients across the rural–urban continuum, and (3) determine how rural and urban health care teams assess and address financial distress in cancer patients.

Methods

Seven research teams within the Cancer Prevention and Research Control Network conducted semi-structured interviews with cancer program staff who have a role in connecting cancer patients with financial assistance services in both rural and urban counties. Interviews were audio-recorded and transcribed. We identified themes using descriptive content and thematic analysis.

Results

We interviewed 35 staffs across 29 cancer care programs in seven states, with roughly half of respondents from programs in rural counties. Participants identified differences in rural and urban patients’ experiences of financial hardship related to distance required to travel for treatment, underinsurance, and low socioeconomic status. Insufficient staffing was an identified barrier to addressing rural and urban patients’ financial concerns.

Conclusions

Improved financial navigation services could mitigate the effects of financial toxicity experienced by cancer patients, particularly rural patients, throughout treatment and survivorship. Future research is needed to improve how cancer programs assess financial hardship in patients and to expand financial navigation services to better serve rural cancer patients.

Nur mit Berechtigung zugänglich

PDQ Adult Treatment Editorial Board. PDQ Financial toxicity and cancer treatment. Bethesda, MD: National Cancer Institute. Updated 06/22/2021. Available at: https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq. Accessed 08/20/2021

Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D (2016) Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol 34(15):1732–1740. https://doi.org/10.1200/jco.2015.63.2232CrossRefPubMedPubMedCentral

Nipp RD, Zullig LL, Samsa G, Peppercorn JM, Schrag D, Taylor DH Jr, Abernethy AP, Zafar SY (2016) Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress. Psychooncology 25(6):719–725. https://doi.org/10.1002/pon.3911CrossRefPubMed

Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18(4):381–390. https://doi.org/10.1634/theoncologist.2012-0279CrossRefPubMedPubMedCentral

Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, Rowland JH (2013) Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer 119(20):3710–3717. https://doi.org/10.1002/cncr.28262CrossRefPubMed

Zahnd WE, Davis MM, Rotter JS, Vanderpool RC, Perry CK, Shannon J, Ko LK, Wheeler SB, Odahowski CL, Farris PE, Eberth JM (2019) Rural-urban differences in financial burden among cancer survivors: an analysis of a nationally representative survey. Support Care in Cancer. https://doi.org/10.1007/s00520-019-04742-zCrossRefPubMed

Charlton M, Schlichting J, Chioreso C, Ward M, Vikas P (2015) Challenges of rural cancer care in the United States. Oncology 29(9):633–640PubMed

Sherman D, Fessele K (2019) Financial support models: a case for use of financial navigators in the oncology setting. Clin J Oncol Nurs 23(5):14–18. https://doi.org/10.1188/19.Cjon.S2.14-18CrossRefPubMed

Yezefski T, Steelquist J, Watabayashi K, Sherman D, Shankaran V (2018) Impact of trained oncology financial navigators on patient out-of-pocket spending. Am J Manag Care 24(5 Suppl):S74-s79PubMed

10.

Spencer JC, Samuel CA, Rosenstein DL, Reeder-Hayes KE, Manning ML, Sellers JB, Wheeler SB (2018) Oncology navigators’ perceptions of cancer-related financial burden and financial assistance resources. Support Care in Cancer 26(4):1315–1321. https://doi.org/10.1007/s00520-017-3958-3CrossRef

11.

Bregar AJ, Alejandro Rauh-Hain J, Spencer R, Clemmer JT, Schorge JO, Rice LW, Del Carmen MG (2017) Disparities in receipt of care for high-grade endometrial cancer: a national cancer data base analysis. Gynecol Oncol 145(1):114–121. https://doi.org/10.1016/j.ygyno.2017.01.024CrossRefPubMed

12.

Vanderpool RC, Nichols H, Hoffler EF, Swanberg JE (2017) Cancer and employment issues: perspectives from cancer patient navigators. J of Cancer Educ 32(3):460–466. https://doi.org/10.1007/s13187-015-0956-3CrossRef

13.

Cancer Prevention and Control Research Network. (2020). Retrieved from: https://cpcrn.org/. Accessed 01/20/2019

14.

US Department of Agriculture. Rural-Urban Continuum Codes. Updated: 12/10/2020 Retrieved from: https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/. Accessed 01/06/2021

15.

Dedoose Version 8.0.35, web application for managing analyzing, and presenting qualitative and mixed method research data (2018) Los Angeles, CA: Socio Cultural Research Consultants, LLC www.dedoose.com

16.

Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15(9):1277–88. https://doi.org/10.1177/1049732305276687

17.

Creswell JW, Poth CN (2018) Qualitative inquiry and research design: choosing among five approaches, 4th edn. SAGE Publications Inc, USA

18.

US Centers for Medicare and Medicaid Services (2020) Eligibility. Medicaid.gov. https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance. Accessed 05/13/2020

19.

US Centers for Medicare and Medicaid Services (2020) Medicare costs at a glance. https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance. Accessed 5/13/2020

20.

National Comprehensive Cancer Network (2020) NCCN distress thermometer and problem list for patients. Retrieved from: https://www.nccn.org/docs/default-source/patient-resources/nccn_distress_thermometer.pdf?sfvrsn=ef1df1a2_4. Accessed 05/13/2020

21.

Hung P, Deng S, Zahnd WE, Adams SA, Olatosi B, Crouch EL, Eberth JM (2020) Geographic disparities in residential proximity to colorectal and cervical cancer care providers. Cancer 126(5):1068–1076. https://doi.org/10.1002/cncr.32594CrossRefPubMed

22.

Lin CC, Bruinooge SS, Kirkwood MK, Olsen C, Jemal A, Bajorin D, Giordano SH, Goldstein M, Guadagnolo BA, Kosty M, Hopkins S, Yu JB, Arnone A, Hanley A, Stevens S, Hershman DL (2015) Association between geographic access to cancer care, insurance, and receipt of chemotherapy: geographic distribution of oncologists and travel distance. J Clin Oncol 33(28):3177–3185. https://doi.org/10.1200/jco.2015.61.1558CrossRefPubMedPubMedCentral

23.

Duggan M, Smith A (2013) Cell internet use 2013. Pew ResearchCenter, Washington, DC https://www.pewresearch.org/internet/2013/09/16/cell-internet-use-2013/. Accessed 09/01/2020

24.

Anderson M (2015) The demographics of device ownership. https://www.pewresearch.org/internet/2015/10/29/the-demographics-of-device-ownership/. Accessed 09/01/2020

25.

Greenberg-Worisek AJ, Kurani S, Finney Rutten LJ, Blake KD, Moser RP, Hesse BW (2019) Tracking healthy people 2020 Internet, broadband, and mobile device access goals: an update using data from the Health Information National Trends Survey. J Med Internet Res 21(6):e13300. https://doi.org/10.2196/13300CrossRefPubMedPubMedCentral

26.

Federal Communications Commission (2019) 2019 Broadband Deployment Report. Washington, D.C. https://docs.fcc.gov/public/attachments/FCC-19-44A1.pdf. Accessed 09/08/2020

27.

Jacobsen PB, Wagner LI (2012) A new quality standard: the integration of psychosocial care into routine cancer care. J Clin Oncol 30(11):1154–1159. https://doi.org/10.1200/jco.2011.39.5046CrossRefPubMed

28.

Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR (2017) Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst 109 (2). https://doi.org/10.1093/jnci/djw205

29.

Tucker-Seeley RD, Thorpe RJ (2019) Material-psychosocial-behavioral aspects of financial hardship: a conceptual model for cancer prevention. Gerontologist 59(Suppl 1):S88-s93. https://doi.org/10.1093/geront/gnz033CrossRefPubMedPubMedCentral

30.

Khera N, Holland JC, Griffin JM (2017) Setting the stage for universal financial distress screening in routine cancer care. Cancer 123(21):4092–4096. https://doi.org/10.1002/cncr.30940CrossRefPubMed

31.

de Souza JA, Yap BJ, Wroblewski K, Blinder V, Araújo FS, Hlubocky FJ, Nicholas LH, O’Connor JM, Brockstein B, Ratain MJ, Daugherty CK, Cella D (2017) Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the COmprehensive Score for financial Toxicity (COST). Cancer 123(3):476–484. https://doi.org/10.1002/cncr.30369CrossRefPubMed

32.

Shankaran V, Leahy T, Steelquist J, Watabayashi K, Linden H, Ramsey S, Schwartz N, Kreizenbeck K, Nelson J, Balch A, Singleton E, Gallagher K, Overstreet K (2018) Pilot feasibility study of an oncology financial navigation program. J Oncol Pract 14(2):e122–e129. https://doi.org/10.1200/jop.2017.024927CrossRefPubMed

33.

Palomino H, Peacher D, Ko E, Woodruff SI, Watson M (2017) Barriers and challenges of cancer patients and their experience with patient navigators in the rural US/Mexico border region. J Cancer Educ 32(1):112–118. https://doi.org/10.1007/s13187-015-0906-0CrossRefPubMed

34.

Petereit D, Omidpanah A, Boylan A, Kussman P, Baldwin D, Banik D, Minton M, Eastmo E, Clemments P, Guadagnolo BA (2016) A multi-faceted approach to improving breast cancer outcomes in a rural population, and the potential impact of patient navigation. S D Med 69(6):268–273PubMed

35.

Torres E, Richman AR, Schreier AM, Vohra N, Verbanac K (2019) An evaluation of a rural community-based breast education and navigation program: highlights and lessons learned. J Cancer Educ 34(2):277–284. https://doi.org/10.1007/s13187-017-1298-0CrossRefPubMed

Titel: How cancer programs identify and address the financial burdens of rural cancer patients
verfasst von: Victoria Petermann
Whitney E. Zahnd
Robin C. Vanderpool
Jan M. Eberth
Catherine Rohweder
Randall Teal
Maihan Vu
Lindsay Stradtman
Elizabeth Frost
Erika Trapl
Sarah Koopman Gonzalez
Thuy Vu
Linda K. Ko
Allison Cole
Paige E. Farris
Jackilen Shannon
Jessica Lee
Natoshia Askelson
Laura Seegmiller
Arica White
Jean Edward
Melinda Davis
Stephanie B. Wheeler
Publikationsdatum: 16.10.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 3/2022
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-021-06577-z

Springer Medizin

How cancer programs identify and address the financial burdens of rural cancer patients